Health IT gets mixed grades for quality, safety

I got this off, its an interesting read 🙂

Evaluations of the impact of health IT on quality and safety show mixed results, but often are missing critical information, according to a new summary report, Incorporating Health IT into Workflow Redesign, prepared by the University of Wisconsin-Madison’s Center for Quality and Productivity Improvement (CQPI).

The report, prepared for the Agency for Healthcare Research and Quality, summarizes research and evidence related to the impact of health IT on workflow in outpatient settings.

Reasons for the mixed results may include a lack of integration of health IT into clinical workflow “in a way that supports the cognitive work of the clinician and the workflows among organizations (e.g., between a clinic and community pharmacy), within a clinic and within a visit,” stated the report, whose co-principal investigators were Pascale Carayon, PhD and Ben-Tzion Karsh, PhD.

The research examined 192 articles related to the impacts of health IT on workflow in outpatient settings and how health IT can be used to assess workflow in these settings. The most common study types were:

  • randomized controlled trials (18 percent);
  • pre-post design without a control group (15 percent);
  • post-implementation analysis without a control group (35 percent); and
  • systematic literature reviews (16 percent).

Primary care was the most common care setting described in the articles (54 percent), followed by primary and specialty care (20 percent).

The most common type of health IT in the literature was decision support systems, including electronic alerts and reminders (40 percent). CQPI researchers divided this category according to the goal of the system; subcategories included:

  • chronic disease management (22 percent);
  • preventive care (14 percent); and
  • medication prescribing (20 percent).

Other types of health IT applications in the literature were EHRs/EMRs (23 percent), telemedicine (19 percent), informational resources for providers and patients (7 percent) and electronic prescribing (4 percent).

“In the literature, we found that health IT had been used to analyze workflow in 54 studies. Most of these were evaluations of health IT usage or functioning, but some examined the time of clinic staff, physician adherence with decision support recommendations, coding accuracy, communication through electronic messaging, and the quality of documentation,” the CQPI study reported.

“Awareness is growing of the need to analyze workflow in order to ensure successful health IT implementation and the potential for health IT to be used in process improvement,” the authors wrote.

“We have discovered that some workflow changes associated with implementation seem to be nearly universal, such as the increased workload of physicians who have implemented an EHR. Others may be unique to the context of a particular clinic, such as the refusal of a physician to use new health IT application.”

“Unfortunately, most of the evidence that fills this report is anecdotal, weakly supported, or otherwise questionable in terms of scientific rigor,” the study stated.

The summmary report can be accessed here.

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